In my personal birth experience, I learned that the right education and true support can make the difference between a passive, mainstream I'll-do-whatever-you-say birth and an active, empowering I-am-strong-and-capable-of-deciding-everything-for-myselfbirth. I switched practices when I was 7 1/2 months pregnant because I didn't want to be on the baby-conveyor-belt that the mainstream maternity system puts all of us on. I wanted individual care with a person I knew would be at my birth and who cared about me and wanted to listen to me and really discuss all of my concerns with me. I wanted someone I could trust during my birth so I didn't have to wonder what was going to happen and if a suggestion was really in my best interest or was just because of some medical convenience.
What made this change? I went to a birth meeting in town and was told by a few of the women there (childbirth educators and doulas) that I could do what I wanted, that this was my birth and my body and I could change practitioners if I wanted to. I was on Medicaid and thought I was trapped with the public health department's program, but I wasn't. Medicaid covers a lot of midwives and OBs. I switched and only looked back to see how amazingly different my birth experience would have been if I hadn't done what I did. I also hired a doula and invited my mother and sister to attend my birth (along with my wonderully supportive husband).
I had an unmedicated, active hospital birth with my wonderful midwife and all the other support people I mentioned above and I don't think I could have done it without hearing a few people telling me that I needed to take control and own this experience because it's not something I will experience often and it's something that will change my life forever.
I'm now a labor doula and I'm working on my childbirth educator certification. That's how much my childbirth experience affected me.
As a childbirth professional, I've learned a lot as well. I've learned that the place and people you surround yourself with at birth can be the difference between a natural birth and a cesarean for having a pelvis that's "too small." I've learned that location and attendants can mean the difference between an epidural and a natural birth. I've learned that some hospital childbirth classes are pretty good and some are horribly awful (call and see if the teacher is certified to teach... many haven't even been trained). I've learned that good education and support make for better experiences, even if the events take turns you didn't want or expect. I've learned that hospitals and doctors do not always have our best interests in mind, even if they have them in their hearts, and you might end up with a "problem" that isn't a problem or a procedure that isn't necessary but may affect you for the rest of your life. I've learned that informed decision making only happens when we ask questions until all our doubts and surmises are fully addressed AND the people answering our questions give their answers based on verifiable evidence, not just hear-say or hunches.
I've learned that a lot of women in America feel like they are broken - that their bodies just can't do birth, at least not naturally. I've also learned that this is often because they weren't given enough support, enough time, enough education, enough power, enough freedom of movement and freedom in general, not because their bodies are broken. The World Health Organization states that cesarean section rates should never rise above 10-15% (even for developing nations) because above this number, women and babies suffer more than they do when birthing vaginally, even when they need assistance there. The national cesarean rate is over 30%. It's not because women are broken. It's because women lack support, time, education, power, and freedom in many birth locations and with many medical attendants.
For instance, homebirth midwives have an average cesarean section rate of 2-4%. Now this is for low-risk women, but aren't most of us low-risk women? There are hospitals in the US with 50% cesarean section rates. Isn't there something wrong with this picture? Women who are given 12 hours to birth their babies after their water has broken are at risk because people are doing vaginal exams! Women whose waters break months prior to their due dates are not induced and given 12 hours to have their babies! No, they're put on bedrest and there are no vaginal exams because that increases their risk of infection. Hmmm... Moms who are induced at 39 or 40 weeks for their first babies are being induced a full 1-2 weeks before the average first-time mother would naturally go into labor! To be sure, doctors and hospitals are wonderful to have when women are in high-risk situations or when the rare low-risk birth needs intervention, but with studies showing that low-risk women giving birth are safer in their homes than in a hospital, isn't there something wrong with the way mainstream birth culture addresses birth?
I've learned a lot about myself and about birth in America since I had my first baby two March's ago and I'm still learning. Now I'm starting to plan for baby #2, who is due sometime in late July-early August. I'm planning a homebirth this time, and not because I had a bad experience in the hospital - I didn't - but because it's statistically safer for me and my baby than a hospital birth and my last birth proved to me that I am powerful and capable and intelligent enough to make this decision for myself. Go figure.
19 November, 2008
13 November, 2008
My rant about the homebirth vs hospital-birth debates.
I think it is wonderful that we are living in a time and place when debates like this are happening. We have access to research and opinions, professional and personal ideas, anecdotal and evidence-based practices in our country's medical system.
I would challenge everyone interested in this issue, standing on any part of the spectrum, to read the Johnson and Daviss studies previously mentioned. Dr. Tuteur, as always is comparing apples to bananas by pointing out low-risk hospital-births compared to ALL home births (planned or not, attended by a midwife or unattended, etc). It has been shown time and again, in this an other countries, that homebirth is just as safe, if not a safer alternative to hospital birth for a low-risk mother with a trained midwife. Could hospital births be just as safe as home births? Yes, but they're statistically not.
This debate is all subjective, however. If a woman lives in an area where all the local hospitals have a 50% cesarean rate (a method of obtaining a child which is more than twice as likely to result in death of the mother as a vaginal birth), you can safely bet that a low-risk mother, and perhaps even high-risk mothers, would be better off birthing at home or going to another state to have their babies.
If a woman lives in an area where the closest hospital is 2 hours from their home, she may be in a difficult predicament for choosing her birth place. In the state of Colorado, where I live, a homebirth must occur within 30 minutes travel time from the home to the hospital. This implies an inherent safety of birthing for low-risk women attended by a CPM.
This debate isn't about making all low-risk women birth their babies at home or making all women birth their babies in hospitals. At least, it shouldn't be that way. It should be about finding the options that result in the most satisfying results, including safety to mother and baby. Of course, we are not all the same and we do not all birth the same. Some women have the best outcomes in a hospital, some at home, some in a freestanding birth center, some in other locales altogether. We can't make decisions based purely on other people's experiences, even when those people are doctors.
We need to be informed consumers and look at the scientific evidence presented to us and listen to our hearts and souls and bodies. If after you have done the research, your heart and soul tells you that the hospital is the place for you, then you're right. Choosing your birth place because everyone else does it that way or because of reasons you haven't researched is asking for trouble. If we find ourselves outright stomping on an alternative we've never looked into, we should challenge ourselves to look into it. We may find that we're right or we may find that we're wrong and our culture has taught us something that is not true or is no longer true.
Yes, mothers and babies in the US suffer from lower mortaliity from birth today than they did in the early 1900s. Why is that? Well, we learned about germs, for one thing, We stopped letting doctors go from cleaning out cadavers to using forceps on birthing women, ungloved and unwashed. When birth went to hospitals, it was more dangerous than homebirth. Read "Brought to Bed" for more on the transition from home to hospital and the numbers associated with this transition. There are plenty of books on the topic and all of them point out that moving births to hospitals was NOT the big change that made birth safer in this country. It was germ theory and penicillin. There were places where birthing in a hospital meant a 50% mortality rate due to infection. It was horrific. No, hospitals are not that bad now, but with 20-50% cesarean rates, you have to wonder.
Speaking of cesarean rates, lets point out that the World Health Organization has proven a cesarean section rate above 10-15%, for industrialized countries, puts women and babies at greater risk of morbidity and mortality than a physiological birth. I already mentioned that mothers are more than twice as likely to die when they have a cesarean as when they have a vaginal birth. And someone said people never die because the doctor is there "in case." Hm... A doctor is trained to see problems and fix them, he or she is not trained to let well-enough alone and see normal variations as normal. An obstetrician is very good at what he/she does, when it is necessary. It is not always necessary, however, and it is certainly not necessary for women to have cesarean sections more than 10% of the time they are just wanting to bring their babies into the world.
Women should not be coerced or forced into having unnecessary interventions in labor and birth, especially when there is evidence to say those interventions are dangerous when used without very careful application. These are the things people should be upset about, not the decisions of some women to birth their babies at home.
First, my definition of safety: your relative chances of suffering physical and psychological damage. This is comparing two cars. They both have 5-star safety ratings under certain circumstances, but they're not the same circumstances.
Is homebirth safe? Yes, but your safety factor depends on some things! Is it safe for a low-risk mother who is attended by a trained midwife with a plan for transfer if mom and midwife decide to go? Yes, this scenario places mom and baby at the same safety level as this same mom in a hospital with a midwife, and if the mother has had babies before, she is safer than at a hospital.
Is it safe for a high-risk mother with the same midwife? Yes, but not as safe as a hospital might be for her and her baby.
Is hospital-birth safe? Again, yes, but it depends! Is it safe for the same low-risk mom as above, who is attended by a hands-off nurse-midwife? Yes, but not as safe as the homebirth would be if she has had babies before. How about the low-risk mom attended by an OB? Hm... this is a tricky one because it greatly depends on the OB's practices. Generally, however, the low-risk mother and her baby, with an OB at a hospital, will be in greater danger of suffering physical and psychological damage than the same mom and baby at home or with a midwife in the hospital. And the high-risk mom in the hospital? Generally safer than at home, still dependent upon her provider, however.
So, it's not all black-and-white. It depends on the mom, the baby, the birth place, and the healthcare provider. That's why it's so important to shop like a consumer when it comes to birth choices. Don't just choose the same car everyone else is going for... sometimes you'll find out that your car isn't worth anything in a few years and you'll need to trade it in. And remember, you can always exchange your car for a better model, sometimes for a lot less money! Plenty of women have changed doctors or switched to a midwife or a homebirth at 8 months pregnant or even later. It's your body and your baby. You should do what feels right for you.
03 April, 2008
April is Cesarean Awareness Month!
31.1% of American babies are born by cesarean section, major abdominal surgery. The World Health Organization has been saying for years that rates above 10-15% for ANY nation are high enough that the risks of the surgery outweight any possible benefits. This means that as much as 20% of new mothers and babies are being put at unnecessary risk.
April has been designated as Cesarean Awareness Month. Take the time this month to learn more about the cesarean rates in the United States, in your state, and in your local area. Visit the International Cesarean Awareness Network's web site and get involved.http://www. ican-online. org.
Consider too, getting involved in fighting for VBAC (Vaginal Birth After Cesarean) by writing to your senators and hospitals that do not "allow" VBAC. In Colorado, the majority of Western Slope hospitals now have VBAC "bans" in place, directly interfering with the human rights of women to birth their babies as nature intended, physiologically. Research has proven time and again that VBAC is safer than an automatic repeat cesarean for the vast majority of women. Medical law makes such bans illegal because they remove a woman's right to choose what will be done to her body. It is a fight worth fighting. Again, the ICAN web site is one to visit to read about this issue.
Get involved. Make change. The health of women and babies depend on it.
17 March, 2008
Am I Too Small to Birth My Baby?
Unless you had a nutritional deficiency as a child, such that you have physically DEFORMED hips or you had a pelvic break that did not heal properly, there is no reason to think that your hips will not be big enough to birth your baby. Humans wouldn't be around if we grew our babies bigger than we could physically push out.
Trust your body. It knows what it's doing and all you have to do is be an active part of your labor throughout and let your body do what it tells you it needs to do.
Any tests that can be done to "make sure" your baby will fit are flawed to the point of uselessness. Only 18% of estimations that say a baby will be "big" are actually correct, and even when a baby is "big," that doesn't mean that the baby will have ANY trouble being born. Also, taking measurements of your hips and the baby's head do not take into account the drastic changes that occur during labor to both your hips and the baby's head to make sure everything fits. If anyone tells you that your baby will not fit, they are almost gauranteed to be completely and utterly wrong and they deserve no more of your time or attention.
Next, how to avoid a baby getting "stuck" is fairly easy:
1 - Do not lie on your back during labor, EVER. Lying on your back is completely unnatural for a woman to do during labor, especially while she is pushing out the baby. Lying on your back is so unnatural, in fact, that the best way to get a baby "unstuck" if the shoulders DO get stuck in the pelvis is to do this amazing thing... get onto your hands and knees. That's usually all it takes. So avoid the whole ordeal in the first place and push your baby out in a position other than on your back.
2 - labor at home for as long as you feel comfortable doing so. The longer you are at the hospital, the more interventions they will want to do to you and the more likely you are to just lie in bed and wait for the baby. Avoid this by staying home as long as you are comfortable doing so.
3 - hire a doula. Doulas are your constant support during labor, helping you get into active positions, reminding you of things you said you wanted to do during labor when you might not be thinking of such things, helping you ask the right questions to make informed decisions, and helping your partner be of the best help possible. Doulas have been found to reduce the chances of a cesarean by 50% (and shorten labor)!
4 - do not be induced unless you have a clear medical reason that makes waiting more dangerous than being induced. Induction has a slew of risks, one of the biggest being c-section. If the induction fails, c-section. If the induction is too painful (and inductions are considerably more painful than natural labor), you'll probably need pain medications, which increase your chance of a c-section. Induction tethers you to the bed because induction makes you high-risk... being tethered to the bed, as I said before, means you're more likely to have baby get stuck, and more likely to have a c-section.
5 - plan on using natural methods of pain relief and if you do want an epidural, waiting until AT LEAST 5 cm dilation. Better yet, plan on not having any pain medication unless your labor is extremely long (longer than 24 hours) or unnaturally painful. Epidurals cause you to stop moving, making it a lot more likely for baby to get stuck. Epidurals make it more likely for you to have a c-section in general. Epidurals make baby more likely to get stuck because your body cannot respond as it normally would to the cues that arise when baby needs you to move or take action. You can't feel, so you can't act.
All of these things are true, regardless of your size and your baby's size.
I also wanted to mention that only about a third of c-sections are necessary, let alone "emergencies." With over 30% of live births being delivered by c-section, it is important for ALL expectant mothers to take an active role in their care and their births. If you have a doctor or midwife with a low c-section rate, you are already in good hands. If your doctor's or midwife's rate is high (more than 25%), then you know you're already setting up for a cesarean section, regardless of your size, and you might want to think about changing to a provider who believes in the female body's ability to birth babies.
Studies have shown that planning a c-section because the baby is suspected to be "too big" is dangerous for mother and baby and does not improve outcomes versus allowing things to go on their natural course.
Trust your body and your baby. They know what they're doing. If you allow your body and your baby to do what they need to do without interfering unnecessarily, you will be amazed at what they can do.
Source(s):
Gonen Ron, Bader David, Ajami Maha. Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. American Journal of Obstetrics & Gynecology. 183(5):1296-1300, November 2000.Klaus, Kennel, and Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, Healthier Birth. 1993.International Cesarean Awareness Network - http://www.ican-online.org
(My quick response to a woman on Yahoo Answers asking when her doctor would be able to tell if she would need a c-section because of her size.)
Trust your body. It knows what it's doing and all you have to do is be an active part of your labor throughout and let your body do what it tells you it needs to do.
Any tests that can be done to "make sure" your baby will fit are flawed to the point of uselessness. Only 18% of estimations that say a baby will be "big" are actually correct, and even when a baby is "big," that doesn't mean that the baby will have ANY trouble being born. Also, taking measurements of your hips and the baby's head do not take into account the drastic changes that occur during labor to both your hips and the baby's head to make sure everything fits. If anyone tells you that your baby will not fit, they are almost gauranteed to be completely and utterly wrong and they deserve no more of your time or attention.
Next, how to avoid a baby getting "stuck" is fairly easy:
1 - Do not lie on your back during labor, EVER. Lying on your back is completely unnatural for a woman to do during labor, especially while she is pushing out the baby. Lying on your back is so unnatural, in fact, that the best way to get a baby "unstuck" if the shoulders DO get stuck in the pelvis is to do this amazing thing... get onto your hands and knees. That's usually all it takes. So avoid the whole ordeal in the first place and push your baby out in a position other than on your back.
2 - labor at home for as long as you feel comfortable doing so. The longer you are at the hospital, the more interventions they will want to do to you and the more likely you are to just lie in bed and wait for the baby. Avoid this by staying home as long as you are comfortable doing so.
3 - hire a doula. Doulas are your constant support during labor, helping you get into active positions, reminding you of things you said you wanted to do during labor when you might not be thinking of such things, helping you ask the right questions to make informed decisions, and helping your partner be of the best help possible. Doulas have been found to reduce the chances of a cesarean by 50% (and shorten labor)!
4 - do not be induced unless you have a clear medical reason that makes waiting more dangerous than being induced. Induction has a slew of risks, one of the biggest being c-section. If the induction fails, c-section. If the induction is too painful (and inductions are considerably more painful than natural labor), you'll probably need pain medications, which increase your chance of a c-section. Induction tethers you to the bed because induction makes you high-risk... being tethered to the bed, as I said before, means you're more likely to have baby get stuck, and more likely to have a c-section.
5 - plan on using natural methods of pain relief and if you do want an epidural, waiting until AT LEAST 5 cm dilation. Better yet, plan on not having any pain medication unless your labor is extremely long (longer than 24 hours) or unnaturally painful. Epidurals cause you to stop moving, making it a lot more likely for baby to get stuck. Epidurals make it more likely for you to have a c-section in general. Epidurals make baby more likely to get stuck because your body cannot respond as it normally would to the cues that arise when baby needs you to move or take action. You can't feel, so you can't act.
All of these things are true, regardless of your size and your baby's size.
I also wanted to mention that only about a third of c-sections are necessary, let alone "emergencies." With over 30% of live births being delivered by c-section, it is important for ALL expectant mothers to take an active role in their care and their births. If you have a doctor or midwife with a low c-section rate, you are already in good hands. If your doctor's or midwife's rate is high (more than 25%), then you know you're already setting up for a cesarean section, regardless of your size, and you might want to think about changing to a provider who believes in the female body's ability to birth babies.
Studies have shown that planning a c-section because the baby is suspected to be "too big" is dangerous for mother and baby and does not improve outcomes versus allowing things to go on their natural course.
Trust your body and your baby. They know what they're doing. If you allow your body and your baby to do what they need to do without interfering unnecessarily, you will be amazed at what they can do.
Source(s):
Gonen Ron, Bader David, Ajami Maha. Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. American Journal of Obstetrics & Gynecology. 183(5):1296-1300, November 2000.Klaus, Kennel, and Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, Healthier Birth. 1993.International Cesarean Awareness Network - http://www.ican-online.org
(My quick response to a woman on Yahoo Answers asking when her doctor would be able to tell if she would need a c-section because of her size.)
08 February, 2008
ACOG Anti-Home Birth Response
The American College of Obstetricians and Gynecologists, ACOG, released a press statement on Wednesday, February 6th, about it's stance on home birth (ACOG 2008). Their statement epitomizes the position of ACOG as representors of their members, not the rights or needs of the women their members provide care for. The statement is riddled with propaganda, including sentences like, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre," and "Choosing to deliver a baby at home is to place the process of giving birth over the goal of having a healthy baby." Allow me to paraphrase and address each paragraph in the statement.
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The first paragraph states that ACOG is opposed to home births, that childbirth is a normal process, that monitoring in a hospital or certified birth center is necessary due to the potential for quickly arising complications.
This seems like a reasonable enough set of statements, except that if a hospital is really the safest place for complications to be addressed, why is it that many hospitals across the country are not equipped to respond to an emergency in the 30 minutes commonly expressed as necessary for an emergency cesarean? Why are VBACs banned in many rural hospitals because of lack of adequate staff for an emergency cesarean when the chances of any other laboring woman needing an emergency cesarean are at similar rates? Why did the 2005 study of outcomes for planned, appropriately attended home births yield similar or better results for maternal and perinatal mortality than did hospital births in the same period (Johnson 2005)? Home births are just as safe or safer for low-risk women who are planning an attended home birth because an adequately trained home birth midwife is able to handle common health needs of childbirth and serves as a first-responder in true emergencies. Home birth midwives with adequate training can recognize the need for hospital transfer, usually long before any true emergency arises.
In Colorado, home births are required to occur within 30 minutes of a hospital. This would negate the worry of adequate access to hospital personnel and equipment, considering that in the event of an emergency transfer, an ambulance would be used and the hospital medical team would be informed of the incoming patient's needs. Hospitals typically take this long to prepare for an emergency anyhow. Considering this Colorado regulation, I fail to see the additional dangers associated with home births attended by trained midwives.
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ACOG "acknowledges" the rights of women to choose their health care providers, but does not support home birth providers or home birth advocates. ACOG also states that they only support midwives certified by ACNM or AMCB.
ACOG is blatently claiming that women should have limited rights to birth attendants and environments! What right have they to dictate what a woman can choose for the "normal physiological process that most women experience," as they state in their first paragraph? This statement should be drastically fought, considering its implied removal of a woman's rights to her body and to informed decisions. This statement might as well say, "Birth is only okay when We are in ultimate control of you. Don't listen to those crazy old granny-midwives. Only We know what is best for you."
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The next statement expresses ACOG's beliefs that home birth is a trend made popular by celebrities, that life-threatening complications can arise during birth, especially for VBACs, and that a woman puts herself and her child at unnecessary risk by giving birth anywhere except a hospital or accredited free-standing birth center. This paragraph contains the amazingly expressive sentence, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."
Considering that only 1% of U.S. births are at home, how could one call this a "trend" at all? What this statement is referring to is Ricki Lake's recent film The Business of Being Born. Ricki Lake has brought home birth to the public eye unlike anything in the past decades, showing America and the world that home birth is not only an option, but a safe and desireable option. This is threatening to ACOG because it may be a cornerstone to a shift in birth philosophies of many Americans. To speak fairly, the movie also increases the likelihood of people choosing home birth when it may not be a good option for them. Instead of better educating the public and expressing the means of making home birth safe for appropriate people, ACOG chooses to blast home birth altogether, implying they are more interested in representing their members than the public good.
Another issue to take up with this statement is that ACOG doesn't put out damning press releases when celebrities glorify elective primary cesareans, even though they are drastically more dangerous (three times the neonatal mortality rate) than home births, when applied to the same low-risk category of women (McDorman et. al. 2006). A low-risk first-time mother electing for an unnecessary primary cesarean versus a low-risk first-time mother electing for a CPM-attended home birth within 30 minutes of a hospital: which would you say is more deserving of a press release of condemnation? It seems the health of mothers and babies is not the only thing of concern to ACOG.
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ACOG applauds themselves for issuing a task force to analyze cesarean rates of physicians and hospitals and to assist said institutions in lowering their rates, if they deem it necessary. They go on to cite obesity, gestational diabetes, and maternal choice as important factors in the rising cesarean section rate, and state that it is impossible to determine a goal for cesarean rates.
I want to point out the irony of this: ACOG supports maternal choice in the cesarean epidemic, but not in home birth, which, as was previously mentioned, is safer than elective cesarean. The reasoning for this discrepancy is obvious: cesareans support ACOG's members, home birth does not. It is also appalling that ACOG would point blame at these groups of women for the cesarean rate, avoiding any statements inplying that their own practices might contrbute to said problems.
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ACOG next states that OB/GYN's may save lives and lower the chances of "bad outcomes" in emergency situations. They also say that they believe the safest place for labor, delivery, and postpartum are hospitals, accredited free-standing birth centers, or birth centers in hospital complexes.
All statements in this paragraph have previously been addressed in this essay.
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The next paragraph states, "studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous." Then ACOG states that midwives cannot perform cesareans or other procedures that would be best for mother and child.
As is obvious from my essay thus far, adequate studies have indeed occurred and have certainly been rigorous enough for change to be made and informed opinions to form. Home birth is at least as safe, if not safer, than hospital birth for low-risk women attended by adequately trained midwives.
It is obvious that midwives, as well as family practitioners and other non-OB attendants, are not able to perform cesareans, but this statement also implies that such medical procedures, which only obstetricians can perform, are necessarily the best for mother and baby. One need only spend a few days on the ICAN email forum to realize that an inexcusable number of women and infants are the victims of unnecessary obstetrical procedures, performed for the "safeguarding" of obstetricians, not of mothers and children. Stories abound of women who were sectioned because their obstetricians had a social obligation, because nobody told them they could try something different, because a cesarean was presented as their only option, because they had a cesarean with the last baby, because the baby was getting "too big," because labor was taking "too long." This list goes on.
If this second statement were to be taken seriously, all hospitals without in-house obstetricians and anesthesiologists available 24-hours a day would have to shut down their maternity wards. This statement basically says that such hospitals are unsafe for labor, childbirth, and postpartum.
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ACOG summarizes their statement by supporting prenatal care and birth plans, hospital or birth center births, and CNMs working with physicians. They also state, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."
This statement, which implies that women do not care for the health of their babies if they choose to birth at home, is ludicrous and false. It also explicitly shows that ACOG does not care at all about the mother, the mother's health, the mother's desires, or what is best for mother and child. Even if the health of the baby were the only goal of ACOG, home births would be the method of choice for many babies.
ACOG is not interested in the health of mothers or babies, however. ACOG is interested in "representing over 52,000 members who provide health care for women." ACOG represents it's members by lying to the public, by attempting to bully people into choosing the more dangerous options, by putting mothers and babies at risk who would not otherwise be there, by allowing their members to perform unnecessary primary cesareans thus endangering the lives of mothers and babies, and by pushing propaganda instead of informing the public of scientifically based risks and benefits. ACOG is obviously not interested in providing health care for women, ACOG is interested in providing under-educated patients for their members to make money from.
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References
ACOG (2008) "ACOG Statement on Home Births" February 6, 2008. Washington, DC. <http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm>.
Johnson, Kenneth C and Betty-Anne Daviss (2005) "Outcomes of planned home births with certified professional midwives: large prospective study in North America" British Medical Journal. 18 June 2005 330:1416. <http://www.bmj.com/cgi/content/abstract/330/7505/1416>.
McDorman, Marian F. PhD, Eugene Declercq PhD, Fay Menacker DrPHCPNP, Michael H. Malloy MDMS (2006) "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with 'No Indicated Risk,'" United States, 1998-2001 Birth Cohorts. Birth 33 (3), 175–182. <http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00102.x>.
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The first paragraph states that ACOG is opposed to home births, that childbirth is a normal process, that monitoring in a hospital or certified birth center is necessary due to the potential for quickly arising complications.
This seems like a reasonable enough set of statements, except that if a hospital is really the safest place for complications to be addressed, why is it that many hospitals across the country are not equipped to respond to an emergency in the 30 minutes commonly expressed as necessary for an emergency cesarean? Why are VBACs banned in many rural hospitals because of lack of adequate staff for an emergency cesarean when the chances of any other laboring woman needing an emergency cesarean are at similar rates? Why did the 2005 study of outcomes for planned, appropriately attended home births yield similar or better results for maternal and perinatal mortality than did hospital births in the same period (Johnson 2005)? Home births are just as safe or safer for low-risk women who are planning an attended home birth because an adequately trained home birth midwife is able to handle common health needs of childbirth and serves as a first-responder in true emergencies. Home birth midwives with adequate training can recognize the need for hospital transfer, usually long before any true emergency arises.
In Colorado, home births are required to occur within 30 minutes of a hospital. This would negate the worry of adequate access to hospital personnel and equipment, considering that in the event of an emergency transfer, an ambulance would be used and the hospital medical team would be informed of the incoming patient's needs. Hospitals typically take this long to prepare for an emergency anyhow. Considering this Colorado regulation, I fail to see the additional dangers associated with home births attended by trained midwives.
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ACOG "acknowledges" the rights of women to choose their health care providers, but does not support home birth providers or home birth advocates. ACOG also states that they only support midwives certified by ACNM or AMCB.
ACOG is blatently claiming that women should have limited rights to birth attendants and environments! What right have they to dictate what a woman can choose for the "normal physiological process that most women experience," as they state in their first paragraph? This statement should be drastically fought, considering its implied removal of a woman's rights to her body and to informed decisions. This statement might as well say, "Birth is only okay when We are in ultimate control of you. Don't listen to those crazy old granny-midwives. Only We know what is best for you."
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The next statement expresses ACOG's beliefs that home birth is a trend made popular by celebrities, that life-threatening complications can arise during birth, especially for VBACs, and that a woman puts herself and her child at unnecessary risk by giving birth anywhere except a hospital or accredited free-standing birth center. This paragraph contains the amazingly expressive sentence, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."
Considering that only 1% of U.S. births are at home, how could one call this a "trend" at all? What this statement is referring to is Ricki Lake's recent film The Business of Being Born. Ricki Lake has brought home birth to the public eye unlike anything in the past decades, showing America and the world that home birth is not only an option, but a safe and desireable option. This is threatening to ACOG because it may be a cornerstone to a shift in birth philosophies of many Americans. To speak fairly, the movie also increases the likelihood of people choosing home birth when it may not be a good option for them. Instead of better educating the public and expressing the means of making home birth safe for appropriate people, ACOG chooses to blast home birth altogether, implying they are more interested in representing their members than the public good.
Another issue to take up with this statement is that ACOG doesn't put out damning press releases when celebrities glorify elective primary cesareans, even though they are drastically more dangerous (three times the neonatal mortality rate) than home births, when applied to the same low-risk category of women (McDorman et. al. 2006). A low-risk first-time mother electing for an unnecessary primary cesarean versus a low-risk first-time mother electing for a CPM-attended home birth within 30 minutes of a hospital: which would you say is more deserving of a press release of condemnation? It seems the health of mothers and babies is not the only thing of concern to ACOG.
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ACOG applauds themselves for issuing a task force to analyze cesarean rates of physicians and hospitals and to assist said institutions in lowering their rates, if they deem it necessary. They go on to cite obesity, gestational diabetes, and maternal choice as important factors in the rising cesarean section rate, and state that it is impossible to determine a goal for cesarean rates.
I want to point out the irony of this: ACOG supports maternal choice in the cesarean epidemic, but not in home birth, which, as was previously mentioned, is safer than elective cesarean. The reasoning for this discrepancy is obvious: cesareans support ACOG's members, home birth does not. It is also appalling that ACOG would point blame at these groups of women for the cesarean rate, avoiding any statements inplying that their own practices might contrbute to said problems.
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ACOG next states that OB/GYN's may save lives and lower the chances of "bad outcomes" in emergency situations. They also say that they believe the safest place for labor, delivery, and postpartum are hospitals, accredited free-standing birth centers, or birth centers in hospital complexes.
All statements in this paragraph have previously been addressed in this essay.
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The next paragraph states, "studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous." Then ACOG states that midwives cannot perform cesareans or other procedures that would be best for mother and child.
As is obvious from my essay thus far, adequate studies have indeed occurred and have certainly been rigorous enough for change to be made and informed opinions to form. Home birth is at least as safe, if not safer, than hospital birth for low-risk women attended by adequately trained midwives.
It is obvious that midwives, as well as family practitioners and other non-OB attendants, are not able to perform cesareans, but this statement also implies that such medical procedures, which only obstetricians can perform, are necessarily the best for mother and baby. One need only spend a few days on the ICAN email forum to realize that an inexcusable number of women and infants are the victims of unnecessary obstetrical procedures, performed for the "safeguarding" of obstetricians, not of mothers and children. Stories abound of women who were sectioned because their obstetricians had a social obligation, because nobody told them they could try something different, because a cesarean was presented as their only option, because they had a cesarean with the last baby, because the baby was getting "too big," because labor was taking "too long." This list goes on.
If this second statement were to be taken seriously, all hospitals without in-house obstetricians and anesthesiologists available 24-hours a day would have to shut down their maternity wards. This statement basically says that such hospitals are unsafe for labor, childbirth, and postpartum.
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ACOG summarizes their statement by supporting prenatal care and birth plans, hospital or birth center births, and CNMs working with physicians. They also state, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."
This statement, which implies that women do not care for the health of their babies if they choose to birth at home, is ludicrous and false. It also explicitly shows that ACOG does not care at all about the mother, the mother's health, the mother's desires, or what is best for mother and child. Even if the health of the baby were the only goal of ACOG, home births would be the method of choice for many babies.
ACOG is not interested in the health of mothers or babies, however. ACOG is interested in "representing over 52,000 members who provide health care for women." ACOG represents it's members by lying to the public, by attempting to bully people into choosing the more dangerous options, by putting mothers and babies at risk who would not otherwise be there, by allowing their members to perform unnecessary primary cesareans thus endangering the lives of mothers and babies, and by pushing propaganda instead of informing the public of scientifically based risks and benefits. ACOG is obviously not interested in providing health care for women, ACOG is interested in providing under-educated patients for their members to make money from.
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References
ACOG (2008) "ACOG Statement on Home Births" February 6, 2008. Washington, DC. <http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm>.
Johnson, Kenneth C and Betty-Anne Daviss (2005) "Outcomes of planned home births with certified professional midwives: large prospective study in North America" British Medical Journal. 18 June 2005 330:1416. <http://www.bmj.com/cgi/content/abstract/330/7505/1416>.
McDorman, Marian F. PhD, Eugene Declercq PhD, Fay Menacker DrPHCPNP, Michael H. Malloy MDMS (2006) "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with 'No Indicated Risk,'" United States, 1998-2001 Birth Cohorts. Birth 33 (3), 175–182. <http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00102.x>.
05 February, 2008
Quick Reply - Avoiding Labor Induction
There are plenty of ways of avoiding induction.
1st - don't go in for the appointment. I know this seems flippant, but you really should keep in mind that all decisions are YOURS to make, with your doctor's advice. They are not your doctor's decisions, your doctor's body, your doctor's baby, etc.
Next, consider the reasons your doctor is recommending induction. If you have not yet reached 42 weeks and everything looks normal and healthy, there may be no medical reason to induce, in which case, inducing may be more dangerous than waiting. Even if you have passed 42 weeks, you still have the option of monitoring the baby and placenta to make sure things are doing well as you wait. If you are not interested in inducing except for when medically indicated, then let your doctor know this and work from there.
There are a number of natural induction methods that are not usually dangerous for you or the baby (consulting medical professional, of course), and certainly not as dangerous as chemical induction. Acupuncture can work (see link below) as can nipple stimulation.
I have only heard of nipple stimulation being dangerous if you continue doing it after a contraction has started... it's much safer than chemical induction though because when you stop stimulating the nipples, the contraction goes it's course and stops. This is unlike chemical induction methods, which can hyperstimulate the uterus to the point of distressing the baby and causing very bad things for the mother. "Hyperstimulation" is also possible with nipple stimulation, of course, but is not nearly as likely as with chemical induction and it is also avoidable simply be stopping the stimulation when a contraction starts. Nipple stimulation is also not as "efficient" as medical inducing agents, meaning that it could take longer to work (good, in my opinion). The other thing is that nipple stimulation isn't done with hospital monitoring, usually, so docs worry about that.
A good question to ask yourself and your doctor when thinking about induction (natural or unnatural) is how likely it is to succeed. If your cervix is not favorable (i.e. closed, hard, posterior), medical induction is more likely to fail and result in a cesarean and "natural" induction may succeed but will probably take a long time.
So the things to do to get your body ready for labor now are to have sex (to start effacing the cervix), walk (to get baby into a good position), and possibly take measures to start contractions (acupressure, nipple stimulation, etc).
While these are ultimately your choices to make, it is not advisable to do anything behind your doctor's back. Letting him/her know what you are thinking or doing is of utmost importance in helping them adequately do their job as your care provider. There may be medical reasons for you NOT to do something that a lay person suggests, and you may only know about these if you talk with your doctor about them. There are always risks to every intervention, and naturally inducing your labor is still an intervention.
You shouldn't necessarily be afraid of doing anything, but you should know the risks involved in all choices before you move forward.
Also... find out what your doctor would do to induce you. What drugs would s/he use. Learn about those drugs. I wouldn't wish a Cytotec/misoprostol induction on anyone in the world. Look into that drug and make your own choices.
http://acupuncture.rhizome.net.nz/Defaul... - acupuncture for pregnancy, childbirth, etc.
1st - don't go in for the appointment. I know this seems flippant, but you really should keep in mind that all decisions are YOURS to make, with your doctor's advice. They are not your doctor's decisions, your doctor's body, your doctor's baby, etc.
Next, consider the reasons your doctor is recommending induction. If you have not yet reached 42 weeks and everything looks normal and healthy, there may be no medical reason to induce, in which case, inducing may be more dangerous than waiting. Even if you have passed 42 weeks, you still have the option of monitoring the baby and placenta to make sure things are doing well as you wait. If you are not interested in inducing except for when medically indicated, then let your doctor know this and work from there.
There are a number of natural induction methods that are not usually dangerous for you or the baby (consulting medical professional, of course), and certainly not as dangerous as chemical induction. Acupuncture can work (see link below) as can nipple stimulation.
I have only heard of nipple stimulation being dangerous if you continue doing it after a contraction has started... it's much safer than chemical induction though because when you stop stimulating the nipples, the contraction goes it's course and stops. This is unlike chemical induction methods, which can hyperstimulate the uterus to the point of distressing the baby and causing very bad things for the mother. "Hyperstimulation" is also possible with nipple stimulation, of course, but is not nearly as likely as with chemical induction and it is also avoidable simply be stopping the stimulation when a contraction starts. Nipple stimulation is also not as "efficient" as medical inducing agents, meaning that it could take longer to work (good, in my opinion). The other thing is that nipple stimulation isn't done with hospital monitoring, usually, so docs worry about that.
A good question to ask yourself and your doctor when thinking about induction (natural or unnatural) is how likely it is to succeed. If your cervix is not favorable (i.e. closed, hard, posterior), medical induction is more likely to fail and result in a cesarean and "natural" induction may succeed but will probably take a long time.
So the things to do to get your body ready for labor now are to have sex (to start effacing the cervix), walk (to get baby into a good position), and possibly take measures to start contractions (acupressure, nipple stimulation, etc).
While these are ultimately your choices to make, it is not advisable to do anything behind your doctor's back. Letting him/her know what you are thinking or doing is of utmost importance in helping them adequately do their job as your care provider. There may be medical reasons for you NOT to do something that a lay person suggests, and you may only know about these if you talk with your doctor about them. There are always risks to every intervention, and naturally inducing your labor is still an intervention.
You shouldn't necessarily be afraid of doing anything, but you should know the risks involved in all choices before you move forward.
Also... find out what your doctor would do to induce you. What drugs would s/he use. Learn about those drugs. I wouldn't wish a Cytotec/misoprostol induction on anyone in the world. Look into that drug and make your own choices.
http://acupuncture.rhizome.net.nz/Defaul... - acupuncture for pregnancy, childbirth, etc.
15 January, 2008
Hospital Corp. of America bans VBAC once again
Another HCA hospital has "banned" VBAC (Vaginal Birth After Cesarean). Bans of this sort force women into unnecessary major surgery, putting themselves at greater risk from surgical complications and complications in future pregnancies. Such bans also go against their legal right to choose and refuse care. It is a basic right upheld by every tenet of related legislation.
The only reason such bans exist is to avoid legal liability of the hospital if something happens during a VBAC and the hospital cannot respond quickly enough. Sounds like a problem with the hospital, not the woman, doesn't it?
What do we do about this? Complain, refuse, know our rights and act on them. Write government representatives and grassroots organizations like MomsRising. Join ICAN (International Cesarean Awareness Network) and get involved. File a grievance with the Chief Compliance Officer at the offending hospital(s).
Refusing to consent to a cesarean can be done on any consent form at the hospital. Simply cross out any wording on the generic consent form, initialing the change, and add that you refuse a cesarean section. You are not required by law to sign a consent form if you are in labor. EMTALA states that labor is an emergency situation in which they must treat you until you have stabalized (birth is complete), and they cannot order you to have an unnecessary cesarean without a court order. A court order would require proving that a cesarean is medically necessary.
Heinous violations of our rights such as these will not change until people take action against them.
For more on hospital VBAC bans, visit the ICAN of Portland website (although not in my state, still has thorough info).
The only reason such bans exist is to avoid legal liability of the hospital if something happens during a VBAC and the hospital cannot respond quickly enough. Sounds like a problem with the hospital, not the woman, doesn't it?
What do we do about this? Complain, refuse, know our rights and act on them. Write government representatives and grassroots organizations like MomsRising. Join ICAN (International Cesarean Awareness Network) and get involved. File a grievance with the Chief Compliance Officer at the offending hospital(s).
Refusing to consent to a cesarean can be done on any consent form at the hospital. Simply cross out any wording on the generic consent form, initialing the change, and add that you refuse a cesarean section. You are not required by law to sign a consent form if you are in labor. EMTALA states that labor is an emergency situation in which they must treat you until you have stabalized (birth is complete), and they cannot order you to have an unnecessary cesarean without a court order. A court order would require proving that a cesarean is medically necessary.
Heinous violations of our rights such as these will not change until people take action against them.
For more on hospital VBAC bans, visit the ICAN of Portland website (although not in my state, still has thorough info).
08 January, 2008
Waterbirth International and alternative birth choices need help!
I'm trying to get the word out about the needs of Waterbirth International. Hopefully we can find a way to make a difference. The organization helps women and communities and countries open the doors to safe alternatives in childbirth, particularly waterbirths. They are currently in dire need of enough finances to keep going.
Barbara Harper said,
"How can you help us stay open to take the next phone call? - to convince the next
obstetrician to incorporate waterbirth into his/her practice - to work with the nurse
midwives to install pools in their facilities? To educate an entire hospital on the benefits of
allowing women freedom of movement in the water. How much is it worth to see waterbirth
become the norm in the US, like it is in the UK? I think we only need a few more years to
make that happen. Do women really want waterbirth to be an available choice in every
hospital? I think so. "
They need help by getting the word out, by getting the information on lists and blogs and forums. They need to be on YouTube and in the general public. They also need money. Although I didn't see this, they could probably use donations for speakers and events. They could use volunteers.
Let's help keep Waterbirth International alive!
Here's what the website says:
For twenty plus years WBI and Barbara Harper have been here guiding mothers and their providers, providing education and birth pools all over the world. We are facing the hard truth that the Gentle Birth World Congress - a fabulous success in every way for international , as well as local attendees - drained all of our resources. We may have to close the doors permanent by January 31st.
We need to raise $200,000 in donations to cover the debts from the Congress and move on to keeping waterbirth alive as an available option.
Can you help us stay open to take the next phone call?
- to convince the next obstetrician to incorporate waterbirth into his/her practice
- to work with the nurse midwives to install pools in their facilities
- to educate an entire hospital on the benefits of allowing women freedom of movement in the water
How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen. Women really do want waterbirth to be an available choice in every hospital. They need choices now, more than ever.
If we need to call every single waterbirth parent personally, we will. We don't want 25 years of pioneering work to end and the vision of safe and beautiful waterbirth to go away.
Please do the following:
~DONATE any amount you can ~Become a member of Waterbirth International
~Buy a birth pool for your local midwives ~Buy a birth pool for yourself
~Buy a birth video and donate Post this message on other sites and blogs
http://www.waterbirth.org
Barbara Harper said,
"How can you help us stay open to take the next phone call? - to convince the next
obstetrician to incorporate waterbirth into his/her practice - to work with the nurse
midwives to install pools in their facilities? To educate an entire hospital on the benefits of
allowing women freedom of movement in the water. How much is it worth to see waterbirth
become the norm in the US, like it is in the UK? I think we only need a few more years to
make that happen. Do women really want waterbirth to be an available choice in every
hospital? I think so. "
They need help by getting the word out, by getting the information on lists and blogs and forums. They need to be on YouTube and in the general public. They also need money. Although I didn't see this, they could probably use donations for speakers and events. They could use volunteers.
Let's help keep Waterbirth International alive!
Here's what the website says:
For twenty plus years WBI and Barbara Harper have been here guiding mothers and their providers, providing education and birth pools all over the world. We are facing the hard truth that the Gentle Birth World Congress - a fabulous success in every way for international , as well as local attendees - drained all of our resources. We may have to close the doors permanent by January 31st.
We need to raise $200,000 in donations to cover the debts from the Congress and move on to keeping waterbirth alive as an available option.
Can you help us stay open to take the next phone call?
- to convince the next obstetrician to incorporate waterbirth into his/her practice
- to work with the nurse midwives to install pools in their facilities
- to educate an entire hospital on the benefits of allowing women freedom of movement in the water
How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen. Women really do want waterbirth to be an available choice in every hospital. They need choices now, more than ever.
If we need to call every single waterbirth parent personally, we will. We don't want 25 years of pioneering work to end and the vision of safe and beautiful waterbirth to go away.
Please do the following:
~DONATE any amount you can ~Become a member of Waterbirth International
~Buy a birth pool for your local midwives ~Buy a birth pool for yourself
~Buy a birth video and donate Post this message on other sites and blogs
http://www.waterbirth.org
04 January, 2008
My letter to Dr. Laura
I'm a labor doula, a non-medical childbirth assistant. Today you had a caller ask about her desires to birth her baby in a free-standing birth center and I have some issues with your responses.
I find it appalling that such an influential woman such as yourself would commend cesareans so nonchalantly when the procedure is at epidemic levels. In the U.S. 31.1% of live births are delivered by cesarean, which is more than three times the safe level for a developed country. Cesareans are causing more harm in this country than good, and nonchalantly commending them for non-medical reasons is only going to compound the problem. Women won't realize that childbirth is a consumer activity until the media personalities make it clear. Women shouldn't be given false security in the safety of cesareans. The surgery is much more dangerous than a vaginal birth unless there is a true emergency or good medical reason for it. If you look into the research and the experiences had by women who have had cesareans, it's apparent that change needs to be made.
Second, out-of-hospital births are actually SAFER than hospital births for low-risk women. The majority of women have low-risk pregnancies. It is actually safer to have a baby at home, if you are low risk, than to have your baby in the hospital. Suggesting that all women give birth in hospitals "just in case" is preaching a distrust in women's bodies and God's design. Hospitals have higher infection rates and higher intervention rates for low-risk women than do home births. Also, infections obtained because of the hospital environment are more likely to be antibiotic-resistant and more problematic. Hospitals oftentimes CAUSE problems for low-risk women that wouldn't have been present in a midwife-attended homebirth or at a free-standing birth center.
Women in this country have more choices regarding pregnancy and childbirth than they ever have had in the past. It is imperitive to the continuation of our rights and safety during childbirth that we educate ourselves and others about the facts of our alternatives. Blindly following the propaganda of the last two hundred years' medical professionals' touting their expertise and knowledge over OUR bodies and babies is scientifically and socially unfounded.
Women/consumers need to understand where science and medicine really can help them and where it is all just bells and whistles and self-preservation. High cesarean rates are not safe for women, high intervention rates are not safe for women, all women having hospital births are not safe for women. We can see all of this by looking at other countries and at the medical and scientific research on the subject.
That's my opinion. I chose to become a doula because I want to help women make informed choices. I don't want to choose what is best for any one person. I only want to help women be smart consumers and to have safe, empowering births.
Thank you,
Christina Rochette
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